I wish patients knew what the ER was for

[HemorrhagicShock]

TING, OR I SWEAR I AM TURNING THIS CAR AROUND.

(My husband jokes that 90% of the reason that he wanted to have kids is so that he could say this.).

But in all seriousness - can we stop lecturing the posters here on what they should, or should not, be doing in their professional lives? And can we stop making assumptions about the experience level of people posting here?

Agreed fully!

I routinely tell people that time during the pandemic was the peak joy of my career. Our reputation amongst lay people skyrocketed, the rest of the house of medicine actually respected us for once, the patient load was truly only emergencies, and being on shift was chill AF. No visitors made patient interactions very fruitful and meaningful. And they were ALWAYS appreciative.

I miss those days dearly (despite at the time also having that lingering thought that I might die from an unknown virus... which speaks volumes about how bad EM has gotten now that I desire to go back to the days when I potentially had a real increased chance of dying on shift)

---

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[hoot504]

Agreed fully!

I routinely tell people that time during the pandemic was the peak joy of my career. Our reputation amongst lay people skyrocketed, the rest of the house of medicine actually respected us for once, the patient load was truly only emergencies, and being on shift was chill AF. No visitors made patient interactions very fruitful and meaningful. And they were ALWAYS appreciative.

I miss those days dearly (despite at the time also having that lingering thought that I might die from an unknown virus... which speaks volumes about how bad EM has gotten now that I desire to go back to the days when I potentially had a real increased chance of dying on shift)

Except that apparently a number of RVU based shops got decimated during this time. I'm not primarily RVU based so otherwise I agree with you.

 

[smq123]

Our reputation amongst lay people skyrocketed, the rest of the house of medicine actually respected us for once, the patient load was truly only emergencies, and being on shift was chill AF.

That's the thing, right?

For once, during COVID, there was an actual barrier to going to the ED - the thought that you'd be sitting in tight quarters with lots of people who might be sick with a deadly virus. So unless you really felt like you were dying (and sometimes, even if you did think you might be dying), you didn't go to the ED because you were scared.

To go to your PCP, even if you're sick, there are lots of barriers. The PCP has to be open. You have to call and see if they have a slot because very few PCPs will see you if you just show up. You have to drive and find parking (and often pay for parking nowadays in many urban areas). You have to wait to be seen. It's a process.

But without the fear of catching COVID, there is no barrier to stop people from going to the ED. As PCPs, we can educate educate educate patients as much as we want, but in the heat of the moment, there is nothing stopping people from hopping into an Uber and going to the hospital. They act first and think later - and many patients do that with everything in life anyway. Going to the ED isn't any different.

Maybe the ED needs a series of neon arches over the entrance. "Walking through these doors will cost you over $20,000. Do you still want to go?" "We've got more viruses on our floors than a wh*rehouse. Do you still want to go?" "You're going to be here for 6 hours before someone sees you. Do you still want to go?" Etc etc etc, just to remind patients that going to the ED isn't a zero risk thing.

 

[Apollyon]

Maybe the ED needs a series of neon arches over the entrance. "Walking through these doors will cost you over $20,000. Do you still want to go?" "We've got more viruses on our floors than a wh*rehouse. Do you still want to go?" "You're going to be here for 6 hours before someone sees you. Do you still want to go?" Etc etc etc, just to remind patients that going to the ED isn't a zero risk thing.

@southerndoc can back me up here. This would be construed as an EMTALA violation. The ONLY thing you can do is encourage the pt to be seen. You can't tell them that you don't have the services, that they'll have to pay for parking, or anything else, except, "we're glad to see you".

 

[HemeOncHopeful19]

Agreed fully!

I routinely tell people that time during the pandemic was the peak joy of my career. Our reputation amongst lay people skyrocketed, the rest of the house of medicine actually respected us for once, the patient load was truly only emergencies, and being on shift was chill AF. No visitors made patient interactions very fruitful and meaningful. And they were ALWAYS appreciative.

I miss those days dearly (despite at the time also having that lingering thought that I might die from an unknown virus... which speaks volumes about how bad EM has gotten now that I desire to go back to the days when I potentially had a real increased chance of dying on shift)

Didn’t half of you get laid off or at least a significant reduction in work hours though?

 

[hoot504]

Didn’t half of you get laid off or at least a significant reduction in work hours though?

Nobody got laid off.

Some hours were reduced. The worst I heard happening was a few resident's contracts got changed/cancelled at the last minute. Last I heard they all landed on their feet though. That was more an overreaction by overreactionary CMG admins.

 

[GonnaBeADoc2222]

That's the thing, right?

For once, during COVID, there was an actual barrier to going to the ED - the thought that you'd be sitting in tight quarters with lots of people who might be sick with a deadly virus. So unless you really felt like you were dying (and sometimes, even if you did think you might be dying), you didn't go to the ED because you were scared.

To go to your PCP, even if you're sick, there are lots of barriers. The PCP has to be open. You have to call and see if they have a slot because very few PCPs will see you if you just show up. You have to drive and find parking (and often pay for parking nowadays in many urban areas). You have to wait to be seen. It's a process.

But without the fear of catching COVID, there is no barrier to stop people from going to the ED. As PCPs, we can educate educate educate patients as much as we want, but in the heat of the moment, there is nothing stopping people from hopping into an Uber and going to the hospital. They act first and think later - and many patients do that with everything in life anyway. Going to the ED isn't any different.

Maybe the ED needs a series of neon arches over the entrance. "Walking through these doors will cost you over $20,000. Do you still want to go?" "We've got more viruses on our floors than a wh*rehouse. Do you still want to go?" "You're going to be here for 6 hours before someone sees you. Do you still want to go?" Etc etc etc, just to remind patients that going to the ED isn't a zero risk thing.

Who cares.

Let em come.

Let em get balance billed, Medicaid or not.

More revenue.

 

[JacobMcCandles]

I feel like every thread there’s always people disagreeing or on separate sides of various issues but it was nice to see everyone come together in solidarity in this thread.

 

[RustedFox]

I feel like every thread there’s always people disagreeing or on separate sides of various issues but it was nice to see everyone come together in solidarity in this thread.

Guy should be allowed to continue.
Where he gave himself away was: "I don't think its so bad; if it were, the higher-ups would do something about it."
He obviously had no idea that the higher-ups view "doing the right thing" as disruptive to revenue flow and legally risky.
Nevermind that the higher-ups never have to deal with the actual problem of patient care; they're safely in their offices doing paperwork and playing with themselves.

 

[hoot504]

Guy should be allowed to continue.
Where he gave himself away was: "I don't think its so bad; if it were, the higher-ups would do something about it."
He obviously had no idea that the higher-ups view "doing the right thing" as disruptive to revenue flow and legally risky.
Nevermind that the higher-ups never have to deal with the actual problem of patient care; they're safely in their offices doing paperwork and playing with themselves.

I dream about a day of reckoning where the Bobs from office space go through the admin offices.

What would you say... you do here

 

[Lexdiamondz]

How much of these inappropriate ER visits are due to inadequate access to decent primary care? I bet that a lot of these patients would vanish if there was such access.

The number of patients I see who come to the ER for non-urgent issues that they have subspecialist follow up with in less than a week is staggering

The primary care stuff I get...but if you're seeing a dermatologist on thursday why the **** am I looking at your rash today?

 

[cyanide12345678]

I just don't understand why you don't feel that the solution to this is at the source? The source being the first heatlhcare encounter that any patient has and that is with some type of primary care provider. I'm arguing it is their responsibility to help the patient "navigate" through the healthcare system.

Too bad he’s blocked, i wanted to respond to this dude. Guess I’m late to the game here.

The solution to this problem isn’t primary care. What’s primary care going to do to fix stupidity?

The solution to this problem is to lift all society out of poverty (poverty and lack of education go hand in hand), improve educational standards so the average person isn’t as dumb, put consequences for using the ER inappropriately ($10 Medicaid co pay), magically improve access to psychiatric care and behavioral health care to help these adults develop coping skills that don’t involve running to the ER within 10 minutes of something happening.

The reality is, most unnecessary ER visits are from people who are poorly educated, suffer from some anxiety disorder, or just don’t pay a penny on going to the ER.

 

[cyanide12345678]

Agreed fully!

I routinely tell people that time during the pandemic was the peak joy of my career. Our reputation amongst lay people skyrocketed, the rest of the house of medicine actually respected us for once, the patient load was truly only emergencies, and being on shift was chill AF. No visitors made patient interactions very fruitful and meaningful. And they were ALWAYS appreciative.

I miss those days dearly (despite at the time also having that lingering thought that I might die from an unknown virus... which speaks volumes about how bad EM has gotten now that I desire to go back to the days when I potentially had a real increased chance of dying on shift)

Agreed one of the best days. Though those were very stressful too because my daughter was less than 3 months old at the time.

 

[thegenius]

Patients also seem to have the expectation that we are capable of doing literally anything in medicine and anytime we don't it's because we're simply disinclined to do so.

Yes!!! I agree. That sentiment has to change. I tell them all the time we are specialist. I know very little. And the ER solves few problems except for those patients who are really sick

 

[thegenius]

How much of these inappropriate ER visits are due to inadequate access to decent primary care? I bet that a lot of these patients would vanish if there was such access.

Probably less than you think. People want tests. They want pills. Primary care can only really do the latter.

 

[VA Hopeful Dr]

Probably less than you think. People want tests. They want pills. Primary care can only really do the latter.

Nailed it. I've never ordered a test before.

The thing is, they want the test NOW. That is what I can't usually do.

 

[smq123]

Nailed it. I've never ordered a test before.

The thing is, they want the test NOW. That is what I can't usually do.

I love it when patients are like, "And you'll call me this afternoon with the results, right? WHAT DO YOU MEAN, NO?!?!?" Sorry, I'll tell my army of elves in the back running our secret lab out of the supply closet to work faster.

 

[Zebra Hunter]

The number of patients I see who come to the ER for non-urgent issues that they have subspecialist follow up with in less than a week is staggering

The primary care stuff I get...but if you're seeing a dermatologist on thursday why the **** am I looking at your rash today?

The angriest I have ever been with a patient was one that had a derm appointment in an hour for a rash she had for two months, and the idiot came to the ER instead.

“Ma’am, please leave and go to your derm appointment”.

“No, I want to get lab work so we can figure out what’s going on.”

“That’s not going to happen. Please leave immediately.”

“So you’re not going to do anything?”

“Ma’am, get the hell out of here and go to your dermatologist appointment.”

 

[Boatswain2PA]

The angriest I have ever been with a patient was one that had a derm appointment in an hour for a rash she had for two months, and the idiot came to the ER instead.

“Ma’am, please leave and go to your derm appointment”.

“No, I want to get lab work so we can figure out what’s going on.”

“That’s not going to happen. Please leave immediately.”

“So you’re not going to do anything?”

“Ma’am, get the hell out of here and go to your dermatologist appointment.”

"I want you to get the BEST medical care you can get, so we need to get you to the right place."

-they argue

"Look, if you were having a stroke, you wouldn't want to be seen by a bone doctor, and if you had a broken leg you wouldn't want to be seen by a brain doctor, right?"

-vacuous nod

"Yeah, because we all specialize in things. You need a SPECIALIST for your (insert nonemergent BS) so you can get the BEST medical care, so GTFO!"

 

[nVictus]

"I want you to get the BEST medical care you can get, so we need to get you to the right place."

-they argue

"Look, if you were having a stroke, you wouldn't want to be seen by a bone doctor, and if you had a broken leg you wouldn't want to be seen by a brain doctor, right?"

-vacuous nod

"Yeah, because we all specialize in things. You need a SPECIALIST for your (insert nonemergent BS) so you can get the BEST medical care, so GTFO!"

Well cant I just see the specialist in the ER?

No? Why not?

I wasted my time coming to the ER

1/5 star review - doctor was a meanie poo poo head

Here are some modules about patient empathy

Hospital continues to advertise people come into the ER for anything without giving the ER resources

 

[RustedFox]

I hope that kid that got banned is still reading this thread and sees these posts. Absolute golden truths illustrated by you guys.

 

[thegenius]

Nailed it. I've never ordered a test before.

The thing is, they want the test NOW. That is what I can't usually do.

I know you've ordered a test LOL but people literally don't want to wait more than like 30 minutes.
We even get grief when we tell patients "the labs and CT for your abdominal pain will take 3-4 hours"

 

[gyngyn]

I hope that kid that got banned is still reading this thread and sees these posts.

Though I can't tell you exactly what they said, I can convey that they requested the ban, it was not done unilaterally.

 

[cyanide12345678]

Though I can't tell you exactly what they said, I can convey that they requested the ban, it was not done unilaterally.

So that’s one way to leave a conversation gracefully while making it seem like you didn’t have a choice. Better optics than to just stop responding i guess lol.

 

[allantois]

The underlying issue of all this is poor health literacy and literacy in general

 

[DocEspana]

The angriest I have ever been with a patient was one that had a derm appointment in an hour for a rash she had for two months, and the idiot came to the ER instead.

“Ma’am, please leave and go to your derm appointment”.

“No, I want to get lab work so we can figure out what’s going on.”

“That’s not going to happen. Please leave immediately.”

“So you’re not going to do anything?”

“Ma’am, get the hell out of here and go to your dermatologist appointment.”

I literally LITERALLY just saw a patient like this a week ago. They had a chronic DVT that had worsened in some way while on anticoagulation. They made an appointment for interventional radiology to remove it on day x at 2pm (or whenever it was. mid afternoonish). The day of the appointment, but in the morning, they decided it was too painful to wait until 2pm so they went to their PCP raising hell demanding to be seen there immediately. PCP was in the system with us and could see the open appointment for 2pm. WROTE THEM A RX FOR 2 PERCOCETS and told them to fill it, go to the hospital, take it in the IR clinic waiting room, and wait for their appointment at 2pm. The patient fills the Rx. Takes it in the emergency room waiting room and checks in to be seen by us at like 1:00 pm stating that they want to see if we can "do some tests and fix it first."

 

[DocEspana]

Well cant I just see the specialist in the ER?

No? Why not?

I wasted my time coming to the ER

1/5 star review - doctor was a meanie poo poo head

Here are some modules about patient empathy

Hospital continues to advertise people come into the ER for anything without giving the ER resources

"I wasted my time coming to the ER"

This always makes my blood boil because inevitably one or more of these things are true

1. they got a massive workup
2. they got all of their symptoms treated at least partially.
3. They got appropriate specialist referral.
4. It was an insanely inappropriate reason to come to the ER and they wasted my time.

 

[RustedFox]

The underlying issue of all this is poor health literacy and literacy in general

Unfortunately, general illiteracy is our responsibility, and liability.

 

[Apollyon]

Unfortunately, general illiteracy is our responsibility, and liability.

I remember the dude I saw for punching a wall who was on disability for illiteracy. You know, a correctable condition.

 

[GonnaBeADoc2222]

"I wasted my time coming to the ER"

This always makes my blood boil because inevitably one or more of these things are true

1. they got a massive workup
2. they got all of their symptoms treated at least partially.
3. They got appropriate specialist referral.
4. It was an insanely inappropriate reason to come to the ER and they wasted my time.

"I wasted my time coming to the ER" implies that that they had something valuable to do as an alternative.

 

[DocEspana]

"I wasted my time coming to the ER" implies that that they had something valuable to do as an alternative.

some of us are 20ish hours into our second run of Baldur's Gate 3 and are very interested in how being the dark urge changes the story beats. Getting back to that is important. I feel for them - but only if that's the reason.

 

[Rekt]

The underlying issue of all this is poor health literacy and literacy in general

Idiocracy was a foreshadowing documentary. America is in first place in the race to the bottom and it’s not even close.

 

[sloh]

Idiocracy was a foreshadowing documentary. America is in first place in the race to the bottom and it’s not even close.

“Three generations of imbeciles are enough.”

 

[NITRAS]

The underlying issue of all this is poor health literacy and literacy in general

A couple good ones from yesterday:

Stopped taking oral vancomycin for c diff because she thought it was causing diarrhea.

Patient on HFNC because they aspirated, like 3rd admission in as many months for aspiration pneumonia. Had a feeding tube cause a jejunal to stomach fistula with severe supra-nuclear palsy. .. . You sure you want to be full code? “We want to re-evaluate it in at least 6 months”. I’m concerned about your prognosis being less than 6 months. “What do you know, can you give him something to eat?” No.

 

[TooMuchResearch]

I remember the dude I saw for punching a wall who was on disability for illiteracy. You know, a correctable condition.

I will forget how to read right now if I can go on disability for it. Wtf.

 

[TooMuchResearch]

Alridy furgut. Wen monee.

 

[Arcan57]

a lot of times "my doctor sent me to the ER" is actually 'the secretary at my doctor's office...'

An attending once pointed out that the people that answer the phones are drawn from the same population as the patients.

 

[VA Hopeful Dr]

Idiocracy was a foreshadowing documentary. America is in first place in the race to the bottom and it’s not even close.

I view this like I do the ever fattening of America: job security

 

[RustedFox]

See; we're smart people.
Chances are - since we were kids, we were taken apart from our peers at one point or another.
Maybe put into an accelerated class or "gifted program" (when I was a kid, this was a thing).
Then, we went to college and our peers at least had enough academic merit for admission.
Same thing with post-grad (med school/MPH program/grad work/whatever).
As the years went on, we had less and less exposure to the average complete dumbbass.
"Average" to us meant looking at our peers, who were already well-above average.
Then, it becomes very unpleasant when you hit actual patient care and realize the truth.

 

[emergentmd]

Why do we need government? Because the vast majority of people are too ignorant to make good decisions. The could not survive without government being the nanny state. They keep voting in the same people without one ounce of knowledge of their platforms. The just vote b/c they are D or R, just vote b/c they tik tock better. Very few people actually vote on a candidates platform or ideology. Thus we will continue to vote in the same buffoons that runs the government. My vote is quite meaningless when my vote is equal to Jane who pushes the D button because that is what she was told to do.

Why do we need ERs and doctors? Because the vast majority of people are too ignorant to make good decisions. See above. Nothing is going to change because our populace is just plain dumb.

So how do I as an ER doctor square this in my head and not get bothered by the 5th anxiety chest pain of the day? Its called job security. I rather my shifts ratio be 9:1 once inch/ten foot putts rather than the other way around. If everyone was educated like me, 90% of ER docs would not exists. I like my job and my 1 inch putts. It gave me the security that every day I walk home, my family is financially secure.

So Keep those insured young Chest pain, dental pain, anxiety, rash, migraine pts coming.

 

[TooMuchResearch]

See; we're smart people.
Chances are - since we were kids, we were taken apart from our peers at one point or another.
Maybe put into an accelerated class or "gifted program" (when I was a kid, this was a thing).
Then, we went to college and our peers at least had enough academic merit for admission.
Same thing with post-grad (med school/MPH program/grad work/whatever).
As the years went on, we had less and less exposure to the average complete dumbbass.
"Average" to us meant looking at our peers, who were already well-above average.
Then, it becomes very unpleasant when you hit actual patient care and realize the truth.

This is true. How many average people do I interact with routinely? Even my personal trainer is working on post graduate training in some area or another.

 

[Arcan57]

Why do we need government? Because the vast majority of people are too ignorant to make good decisions. The could not survive without government being the nanny state. They keep voting in the same people without one ounce of knowledge of their platforms. The just vote b/c they are D or R, just vote b/c they tik tock better. Very few people actually vote on a candidates platform or ideology. Thus we will continue to vote in the same buffoons that runs the government. My vote is quite meaningless when my vote is equal to Jane who pushes the D button because that is what she was told to do.

Why do we need ERs and doctors? Because the vast majority of people are too ignorant to make good decisions. See above. Nothing is going to change because our populace is just plain dumb.

So how do I as an ER doctor square this in my head and not get bothered by the 5th anxiety chest pain of the day? Its called job security. I rather my shifts ratio be 9:1 once inch/ten foot putts rather than the other way around. If everyone was educated like me, 90% of ER docs would not exists. I like my job and my 1 inch putts. It gave me the security that every day I walk home, my family is financially secure.

So Keep those insured young Chest pain, dental pain, anxiety, rash, migraine pts coming.

Are we back to debating politics in this forum? Why you gotta be like that?

 

[TrailRun]

Why do we need government? Because the vast majority of people are too ignorant to make good decisions. The could not survive without government being the nanny state. They keep voting in the same people without one ounce of knowledge of their platforms. The just vote b/c they are D or R, just vote b/c they tik tock better. Very few people actually vote on a candidates platform or ideology. Thus we will continue to vote in the same buffoons that runs the government. My vote is quite meaningless when my vote is equal to Jane who pushes the D button because that is what she was told to do.

Why do we need ERs and doctors? Because the vast majority of people are too ignorant to make good decisions. See above. Nothing is going to change because our populace is just plain dumb.

So how do I as an ER doctor square this in my head and not get bothered by the 5th anxiety chest pain of the day? Its called job security. I rather my shifts ratio be 9:1 once inch/ten foot putts rather than the other way around. If everyone was educated like me, 90% of ER docs would not exists. I like my job and my 1 inch putts. It gave me the security that every day I walk home, my family is financially secure.

So Keep those insured young Chest pain, dental pain, anxiety, rash, migraine pts coming.

I think your latter point is true, but part of my stress is that those low acuity patients wait several hours and then are understandably frustrated. And I'm frustrated because I've just told someone they are dying of cancer, pronounced someone, etc, and then an ankle sprain is berating me about the wait. The staffing/system is not set up for the overwhelming volume of these patients. At least in single coverage, we cannot take great care of both really sick people and really not sick people simultaneously

 

[emergentmd]

Are we back to debating politics in this forum? Why you gotta be like that?

Not trying to go down the politics rabbit hole at all. Just saying that our ignorant population is not isolated to medicine. Thus we need too many docs and too many politicians. It is all the same.

Knock on wood. If everyone worked out and tried to eat healthy like me, They may need 1 big hospital for a 1M population not the 10+ that is in my City.

 

[Fox800]

Why do we need government? Because the vast majority of people are too ignorant to make good decisions. The could not survive without government being the nanny state. They keep voting in the same people without one ounce of knowledge of their platforms. The just vote b/c they are D or R, just vote b/c they tik tock better. Very few people actually vote on a candidates platform or ideology. Thus we will continue to vote in the same buffoons that runs the government. My vote is quite meaningless when my vote is equal to Jane who pushes the D button because that is what she was told to do.

Why do we need ERs and doctors? Because the vast majority of people are too ignorant to make good decisions. See above. Nothing is going to change because our populace is just plain dumb.

So how do I as an ER doctor square this in my head and not get bothered by the 5th anxiety chest pain of the day? Its called job security. I rather my shifts ratio be 9:1 once inch/ten foot putts rather than the other way around. If everyone was educated like me, 90% of ER docs would not exists. I like my job and my 1 inch putts. It gave me the security that every day I walk home, my family is financially secure.

So Keep those insured young Chest pain, dental pain, anxiety, rash, migraine pts coming.

I appreciate your view because it gives you a break and it "pays the bills" (if you're paid on production).

Unfortunately, this destroys our emergency health care systems. EDs in the US, Canada, the UK, etc are drowning in surging volumes from general dumba**ery and lack of responsibility from patients to divert non-acute issues to primary care, telemedicine, urgent care, or even Googling basic first aid. God help you if your patient population skews towards entitlement/general Karen-ism.

While easy cases "pay the bills" they limit resources, increase patient mortality from boarding in the ED/overcrowding, hamper our ability to focus on truly acute/emergent issues, leads to physician and nurse burnout from high volumes -> career exodus -> understaffing -> new grads -> increased mortality and slow throughput, and taxes our healthcare system as a whole.

"But it's easy/muh RVUs $$$$" is toxically short-sighted.

I understand that your viewpoint on this is different because you have ownership stake in FSEDs. You can screen out low-acuity complaints or people that can't/won't pay/Medicaid for non-emergent BS.

Many of us do not have the luxury of working at a place that politely sends patients away after a wallet biopsy - I've worked in privately-owned FSEDs, I know how that works.

I get that you don't have to use any brain cells to prescribe a topical steroid for a rash or discharge a viral URI, but EDs in most English-speaking first world countries are drowning in this **** and patients and our family members ARE the ones that suffer when there are no beds, they don't see a doctor in a timely manner for an emergent problem, or there aren't enough nurses to work because most EDs are such a dumpster fire these days.

 

[Arcan57]

I appreciate your view because it gives you a break and it "pays the bills" (if you're paid on production).

Unfortunately, this destroys our emergency health care systems. EDs in the US, Canada, the UK, etc are drowning in surging volumes from general dumba**ery and lack of responsibility from patients to divert non-acute issues to primary care, telemedicine, urgent care, or even Googling basic first aid. God help you if your patient population skews towards entitlement/general Karen-ism.

While easy cases "pay the bills" they limits resources, increases patient mortality from boarding in the ED/overcrowding, decreases our ability to focus on truly acute/emergent issues, leads to physician and nurse burnout from high volumes, and taxes our system as a whole. "But it's easy/muh RVUs $$$$" is toxically short-sighted.

I understand that your viewpoint on this is different because you have ownership stake in FSEDs. You can screen out low-acuity complaints or people that can't/won't pay/Medicaid for non-emergent BS.

Many of us do not have the luxury of working at a place that politely sends patients away after a wallet biopsy - I've worked in privately-owned FSEDs, I know how that works.

I get that you don't have to use any brain cells to prescribe a topical steroid for a rash or discharge a viral URI, but EDs in most English-speaking first world countries are drowning in this **** and patients and our family members ARE the ones that suffer when there are no beds, they don't see a doctor in a timely manner for an urgent complaint, or there aren't enough nurses to work because most EDs are such a dumpster fire these days.

Study after study shows that it’s not the UC Bs that’s clogging EDs. It’s horizontal ESI 3s who need a bunch of tests and imaging and may take up an ED bed indefinitely if they’re waiting for an inpatient bed. The low acuity stuff is a doc dissatisfier in most cases but they don’t really impact flow. If you’re spending your shift seeing patients in the WR, it’s not the worried well that are the reason.

 

[Fox800]

Study after study shows that it’s not the UC Bs that’s clogging EDs. It’s horizontal ESI 3s who need a bunch of tests and imaging and may take up an ED bed indefinitely if they’re waiting for an inpatient bed. The low acuity stuff is a doc dissatisfier in most cases but they don’t really impact flow. If you’re spending your shift seeing patients in the WR, it’s not the worried well that are the reason.

I don't care about what studies from whatever academic EDs show.

Academic EM is not the real world, and studies from Kaiser EDs are not representative of most community EDs.

I do know what it's been like working in community EDs with single or double coverage in various parts of the US before, during, and after COVID, including now, and it sucks.

Adding 20+ people to the WR that want med refills, topical steroids, antibiotics for a toothache, chronic whatever pain, chronic wounds/lymphedema, snotty-nosed screaming kids with a URI, lymphedema, dumps from urgent care for 2nd degree type 1 block, low-energy MVCs that happened 3 days ago, random dumps from PD for jail clearance because they're on metformin (why doesn't the jail have an LVN and an on-call physician for stupid stuff like this?), etc DOES take away time and mental energy from your physicians, nurses, and the entire ED. Not to mention adding all of those charts to finish.

If you have the luxury of having a dedicated doc working fast-track to immediately dispo all of this nonsense - good for you. Most of us have to deal with that AND the ESI 1/2s and ambulance patients arriving multiple times per hour.

 

[emergentmd]

I appreciate your view because it gives you a break and it "pays the bills" (if you're paid on production).

Unfortunately, this destroys our emergency health care systems. EDs in the US, Canada, the UK, etc are drowning in surging volumes from general dumba**ery and lack of responsibility from patients to divert non-acute issues to primary care, telemedicine, urgent care, or even Googling basic first aid. God help you if your patient population skews towards entitlement/general Karen-ism.

While easy cases "pay the bills" they limit resources, increase patient mortality from boarding in the ED/overcrowding, hamper our ability to focus on truly acute/emergent issues, leads to physician and nurse burnout from high volumes -> career exodus -> understaffing -> new grads -> increased mortality and slow throughput, and taxes our healthcare system as a whole.

"But it's easy/muh RVUs $$$$" is toxically short-sighted.

I understand that your viewpoint on this is different because you have ownership stake in FSEDs. You can screen out low-acuity complaints or people that can't/won't pay/Medicaid for non-emergent BS.

Many of us do not have the luxury of working at a place that politely sends patients away after a wallet biopsy - I've worked in privately-owned FSEDs, I know how that works.

I get that you don't have to use any brain cells to prescribe a topical steroid for a rash or discharge a viral URI, but EDs in most English-speaking first world countries are drowning in this **** and patients and our family members ARE the ones that suffer when there are no beds, they don't see a doctor in a timely manner for an emergent problem, or there aren't enough nurses to work because most EDs are such a dumpster fire these days.

It has nothing to do with FSER or where someone works. This is the reality of medicine. You can fight it and get burned out or accept it and play the game.

If the decision makers really wanted to medicine, they would but no one wants to make the hard decisions. They all want votes and you don't want to be the law maker who denied Jim Bob of ER care for a ST who died of epiglottis.

Keep fighting the fight if you want, but nothing will change.

But yeah, I like my job security and deep down inside you do to. If you spent 400K and 10 yrs for your MD degree only to make 100k/yr or be in the unemployment line, you will regret your idealistic stance.

 

[Fox800]

It has nothing to do with FSER or where someone works. This is the reality of medicine. You can fight it and get burned out or accept it and play the game.

If the decision makers really wanted to medicine, they would but no one wants to make the hard decisions. They all want votes and you don't want to be the law maker who denied Jim Bob of ER care for a ST who died of epiglottis.

Keep fighting the fight if you want, but nothing will change.

But yeah, I like my job security and deep down inside you do to. If you spent 400K and 10 yrs for your MD degree only to make 100k/yr or be in the unemployment line, you will regret your idealistic stance.

Let's get real. Working in a privately-owned FSED that you part-own, seeing 1 PPH, watching Netflix and drinking coffee, with the ability to turn away patients with non-emergent complaints that don't pay well (cough Medicaid cough) is NOT the same deal as working in a meat-grinder community ED.

I understand you want to relate with folks here and cut your chops in busy community EDs for years, but your situation is NOT typical for most people and kind of comes off as "how do you do, fellow kids?"

You definitely got in to EM at a great time, bought into a business at a great time, and have had great luck over the years with investments and ownership stakes. I'm happy for you. You're the 0.00001% of EM docs in 2024.

I'm not yelling at clouds or advocating anyone to be "in the unemployment line", but working at busy community EDs is not as sweet as a deal as it was pre-COVID or even 5-10 years ago. It sucks.

No one is saying quit medicine, or drop to a 100k salary - that's hyperbolic.

Most of us are saying buyer beware when it comes to EM, but you're acting like the rest of us are raging for the sake of raging or would voluntarily be unemployed? C'mon.

 

[emergentmd]

I worked 20 yrs in the community and probably did more years than most. I have worked locums in some terrible ERs. Its not like I jumped on the Unicorn Train and looking down on everyone. I bet I spent more time in the pit than you. I also understand supply and demand, so lets stop the talk of sending non urgent pts away.

But it remains that if 80% of non-ER pts didn't go to the ER, e your job would be 100x more difficult and make 1/2 of what you are now.

Imagine every pt requiring extensive work ups, admissions, critical care. Then imagine that 80% of the ERs shut down b/c there are no patients. Now imagine that you are fighting for the same job with 4 other docs. Now imagine that your pay is $120/hr because that is what someone will take.

I am also not advocating that ER is a great or even good job. I am just saying Non ER pts going to the ER makes it a better job. Prove me wrong